AMCN
- 1. Major Obstetrical Complications of Pregnancy Spontaneous Abortion (MISCARRIAGE) Spontaneous Abortion (MISCARRIAGE) is the ending of a pregnancy before week 20. (Pregnancy loss after 20 weeks is considered a stillbirth.) Chromosomal abnormalities cause most spontaneous abortions in the first trimester. Other causes in the first trimester include maternal hormonal imbalances, chronic disease, infection, implantation abnormalities, and exposure to teratogenic chemicals in the environment. Spontaneous abortion between 14 and 20 weeks of gestation is often associated with cervical insufficiency, infection, uterine defects such us bicornate uterus, or fibrous tumors of the uterus.
- 2. How common is miscarriage? Miscarriage is very common. Because many or even most miscarriages occur so early in pregnancy that a woman might not have known that she was pregnant, it is difficult to estimate how many miscarriages occur. Some experts believe that about half of all fertilized eggs die before implantation or are miscarried. Of known pregnancies (in which a woman misses a period or has a positive pregnancy test), about 10% to 20% end in miscarriage.
- 3. Risk factors for miscarriage include the following: • Older maternal age • Cigarette Smoking (>10 cigarettes/day) • Moderate to high alcohol consumption • Trauma to the uterus • Radiation exposure • Previous miscarriage • Maternal weight extremes (BMI either below 18.5 or above 25 kg/m2) • Anatomical abnormalities of the uterus • Illicit drug use • Use of non-steroidal anti-inflammatory drugs (NSAIDs) around the time of conception may increase the risk of miscarriage
- 4. What are the types of miscarriage? Threatened abortion: a woman may experience vaginal bleeding or others signs of miscarriage, but miscarriage has not occurred Incomplete abortion: some of the products of conception (fetal and placental tissues) have been expelled from the uterus, but some remain within the uterus Complete abortion: all of the tissue from the pregnancy has been expelled Missed abortion: the fetus has not developed, so there is no viable pregnancy, but there is placental tissue contained within the uterus Septic abortion: a miscarriage in which there is infection in the fetal and pregnancy material before or after a miscarriage Inevitable or Imminent Recurrent/ Habitual
- 5. What are signs and symptoms of a miscarriage? Vaginal bleeding .All vaginal bleeding during pregnancy should be investigated, although not all instances of bleeding result from a miscarriage. Bleeding in the first trimester of pregnancy is very common and does not typically signify a miscarriage. The pain tends to be dull and cramping, and it may come and go or be present constantly pelvic pain are the hallmark symptoms of miscarriage.
- 6. Precipitating Factor -8 weeks AOG (occurs during first trimester of pregnancy) No Precipitating Factor -Age common among women over 35 years old -Rare no significant racial differences During egg implantation egg slightly separates Blood collects between the chrorionic membrane ( a membrane that develops around a fertilized egg) and the wall of the uterus Blood leaks in the cervix Minimal vaginal spotting/bleeding Risk for miscarriage and still birth (threatened Abortion)
- 7. What happens after a miscarriage? There are no specific treatments that can stop a miscarriage, although women who are at risk and have not yet miscarried may be advised to rest in bed, abstain from sexual activity, and restrict all activity until any warning signs are no longer present. Once a miscarriage occurs, there is no treatment available. In many cases, the miscarriage will take its course, and unless there is severe pain and cramping or severe blood loss, no treatment is required. If a miscarriage does not completely clear the pregnancy tissue from the uterus, a procedure known as a dilation and curettage (D&C) can be performed to remove the remaining pregnancy material.
- 8. Is treatment is used in the case of a missed abortion, for example, when the pregnancy material is not expelled from the uterus. As mentioned above, women who are Rh-negative will receive a dose of rho-D immune globulin to prevent complications in future pregnancies. If a miscarriage is due to infection, antibiotic treatment will be given. Miscarriage is such a common occurrence that typically, unless known risk factors are present, no special testing is performed. For couples who have experienced more than two miscarriages, diagnostic studies to detect genetic, hormonal, or anatomical problems may be recommended. Some doctors recommend evaluation of the couple after the second miscarriage, particularly if the woman is over 35 years of age.
- 9. Can miscarriage be prevented? There is no evidence that bed rest can help prevent miscarriage, but women who have vaginal bleeding during pregnancy are often advised to rest and limit sexual activity until there are no more potential signs of miscarriage. It is possible that some risk factors for miscarriage can be minimized by maintaining a healthy weight and avoiding the use of alcohol, illicit drugs, or tobacco. Screening for and treatment of any sexually transmitted disease (STDs) can also reduce the risk of a miscarriage. Avoidance of sports such as horseback riding or skiing can reduce your risk of trauma to the uterus. In most instances, however, the cause of a miscarriage is outside of the woman's control.
- 10. What Is Ectopic Pregnancy? Ectopic pregnancies occur when a fertilized egg fails to attach to the uterus. In most ectopic pregnancies, the egg will attach to the fallopian tubes. Less common, it may also attach to the abdominal cavity or cervix. Ectopic pregnancies occur in one out of every 50 pregnancies. Outside the uterus, a fertilized egg has virtually no chance of survival. This condition may cause serious health complications if not treated. As such, immediate treatment is highly recommended. Early treatment may prevent fertility problems as well as future health complications.
- 13. What Causes Ectopic Pregnancy? • The cause of an ectopic pregnancy is not clear in all cases. In some cases, the following conditions have been linked with the abnormal pregnancy: • inflammation and scarring of the fallopian tubes from a previous medical condition or surgery • hormonal factors • medical conditions that affect the shape and condition of the fallopian tubes and reproductive organs
- 14. Who Is at Risk for Ectopic Pregnancy? • advanced maternal age of 35 years or older • history of pelvic surgery, abdominal surgery, or multiple abortions • history of endometriosis • conception occurred despite tubal ligation or IUD • conception aided by fertility drugs or procedures • smoking • previous ectopic pregnancies • Hormonal imbalance
- 15. What Are the Symptoms of Ectopic Pregnancy? • Nausea and sore breasts, which are also common in a normal pregnancy, are common in ectopic pregnancies. Other symptoms more clearly point to an abnormal pregnancy. The following symptoms should be discussed with your doctor: • sharp waves of pain in the abdomen, pelvis, shoulder, or neck • light to heavy vaginal spotting or bleeding • dizziness or fainting • rectal pressure
- 16. Diagnosing Ectopic Pregnancy If you suspect an ectopic pregnancy, see your healthcare provider as soon as possible. Ectopic pregnancies cannot be diagnosed from the outside. Your doctor may perform a physical exam to rule out other factors. If an ectopic pregnancy is suspected, a blood test can assess hCG and progesterone levels. If hormone levels are not typical, additional tests will be required. If blood tests point to a problem, your doctor will perform a transvaginal ultrasound. This will locate the fertilized egg and confirm an ectopic pregnancy diagnosis. In extreme cases, the fallopian tube may rupture and bleed. A surgeon may then perform an emergency laparotomy by making an incision in the abdomen. This procedure is used not only to diagnose an ectopic pregnancy, but to provide immediate treatment.
- 17. Treating Ectopic Pregnancy • Medications If your physician concludes that immediate complications are unlikely, he or she may inject a drug called methotrexate. Methotrexate stops the growth of rapidly dividing cells, such as the cells of the embryo. Regular blood tests will ensure that the drug is effective. Methotrexate does not carry the same risks of fallopian tube damage that come with surgery.
- 18. • Surgeries Many surgeons choose laparoscopic surgery to remove the embryo and repair any internal damage. Under anesthesia, a small camera is inserted through an incision in the abdomen. Additional incisions may be made that allow other tools to remove the embryo and repair damage to the fallopian tube. If the surgery is unsuccessful, a laparotomy will be performed through a larger incision. • If the fallopian tube has ruptured or is severely damaged, it may need to be removed during surgery. • Home Care Patients will be advised to rest. Follow-up appointments can confirm that the embryo has been completely removed or reabsorbed.
- 20. Hydatidiform Mole A hydatidiform mole is a growing mass of tissue inside your womb (uterus) that will not develop into a baby. It is the result of abnormal conception. It may cause bleeding in early pregnancy and is usually suspected on an early pregnancy ultrasound scan. It needs to be removed and most women can expect a full recovery. However, close follow-up is needed after a hydatidiform mole because there is a small chance of developing a type of cancer. If a cancer does develop, effective treatment is available and most women can be cured.
- 21. • patho
- 22. What are the symptoms of a hydatidiform mole? Women with a hydatidiform mole usually have higher-than-average levels of the pregnancy hormone human chorionic gonadotrophin (hCG) compared with women with a normal pregnancy. This hormone is produced by the trophoblastic tissue. It is the hormone that is detected in a standard pregnancy test. The high levels of hCG occur because there is an excessive amount of trophoblastic tissue with a hydatidiform mole. The high hCG levels are responsible for some of the symptoms.
- 23. What is the treatment for a hydatidiform mole? If you have a hydatidiform mole, you will need to have it removed. This means having a small operation. This is done in hospital by a doctor who is a gynaecology specialist. You will be given an anaesthetic. In most cases, a small tube is passed into your womb (uterus) through the opening of your uterus (your cervix) and the abnormal tissue is removed by suction. The tissue is then sent off to the laboratory for examination under the microscope.
- 24. Placental Abruption After a woman gives birth and the umbilical cord has been cut, her body sends a signal to her uterus that the placenta is no longer needed. The placenta then begins to peel away from the uterine wall so that it can leave the body following the path the baby just took. Sometimes, the placenta begins to peel away from the uterus too soon, while the baby still needs the placenta to supply oxygen and nutrients. This is called placental abruption or just abruption.
- 25. Doctors aren't sure exactly how placental abruption occurs. Many believe, however, that tiny blood vessels on the surface of the placenta begin to leak and form a bruise or blood blister, which then spreads between the placenta and the uterine wall. The blood loosens the connection between the uterine wall and the placenta, allowing it to separate.
- 26. Non Modifiable -Traumatic Injury -Inc. Maternal Age 30 years and above -Hx of abruptio placenta Socio economic Modiafiable -Smoking -Use of cocaine -Multiple Gestation -Malnutrition Decrease resiliency of blood vessels at placental bed Torn of ruptured vessels Partial Separation Total Separation Peripheral portion is detached mild to moderate vaginal bleeding Central portion is detached mild to moderate concealed bleeding Blood is trapped to intact peripheral Massive vaginal or Conceived hemorrhage Fetal Death
- 27. When a woman has placental abruption, the most common signs are: • vaginal bleeding; • abdominal tenderness or back pain; • contractions; and • abnormalities in the baby's heartbeat. Factors that increase a woman's risk for abruption include: • high blood pressure • past pregnancies • past placental abruptions • smoking • street drugs, • preterm premature rupture of membranes
- 28. How Common is Placental Abruption? Abruption is a common complication of pregnancy. About one in 20 women probably have small abruptions, but these are small enough they do not affect the mother or her baby. In fact, doctors rarely know that these abruptions exist. About one in 120 women who deliver has a larger abruption, and about one in 830 has an abruption so severe that the baby cannot survive.
- 29. The main risks associated with placental abruption include: • heavy bleeding -the amount of bleeding depends on how much of the placenta has separated from the uterine wall. The more separation that occurs, the greater the amount of bleeding; and • disruption in the blood's ability to clot (disseminated intravascular coagulation, or DIC)-DIC occurs as a complication of serious illness or heavy blood loss. DIC is a serious condition because once the clotting mechanisms of the blood have been disrupted, it is difficult to get them working again. This results in additional blood loss.
- 30. What Is Placenta Previa? • Placenta previa is a condition in which the placenta attaches to the wall of the lower portion of the uterus and covers all or part of the cervix. Doctors classify placenta previa according to the placenta's location on the uterine wall and how completely the placenta covers a woman's cervix:
- 31. • complete -the placenta covers the entire opening of the cervix. If the placenta is centered exactly over the cervical opening, it may be called a central previa; • partial -the placenta covers a significant part of the cervix, but not the entire area; and • marginal -the placenta reaches the edge of the cervical opening, but doesn't actually cover any part of it.
- 33. Predisposing Factor -Age -Gender -Genetic Precipitating Factors -Hx of Placenta Previa -Multi Para -Smoking Progesterone and Estrogen level Pre embryonic stage Production of fertile ovum Implantation in the ovum Embryonic stage Placenta arise from the thropoblast tissue Insufficient blood Placenta migrates to where there is sufficient blood supply
- 34. Placenta resides in the lower Total placenta Previa The placenta completely covers the top of the cervix Partial Placenta The placenta partially covers the top of the cervix Marginal Placenta Touches but does not cover the top of the cervix Low lying pla The Placenta encroaches th lower segment of the uterus but does not infringe on the cervical os Profuse bright red bleeding Painless vaginal bleeding If treated and managed -Avoidance several intercourse and vaginal examinations -frequent check ups Good prognosis If not treated and managed Profuse bleeding Hypotension Poor prognosis Hypovolemic Shock Coma Death of Mother and Fetus
- 35. How Common Is Placenta Previa? About 30% of pregnant women have placenta previa early in their pregnancies; however, most of the time this spontaneously resolves as the pregnancy progresses. By the time a woman is within a couple of weeks of her due date, the chance of placenta previa drops to less than 1%. The reason placenta previa is less common in late pregnancy has to do with the way the uterus stretches over the nine months. The top half of the uterus tends to stretch more easily than the bottom half so that, as the baby grows, the uterus pulls the placenta up and away from the cervix. This is called placental migration.
- 36. What Causes Placenta Previa? Although the exact cause of placenta previa is unknown, the following risk factors suggest that some cases may be caused by previous scarring of the wall of the uterus: • history of cesarean section; • previous pregnancy; • previous dilation and curettage (scraping) for miscarriage or abortion; and • maternal age 35 or older.
- 37. What Are the Signs of Placenta Previa? Placenta previa is usually characterized by vaginal bleeding in the late second or third trimester. However, placenta previa often causes no symptoms throughout the pregnancy and is often diagnosed only during a routine ultrasound. When an abdominal ultrasound does not allow the doctor to see the relationship between the placenta and the cervix, ultrasound may be conducted carefully through the vagina.
- 38. Potential Complications from Placenta Previa For the baby, preterm delivery (and the complications resulting from it) is the most common potential complication of placenta previa. Preterm delivery occurs in nearly two- thirds of placenta previa cases. Babies are usually delivered early because of dangerous amounts of bleeding. Complications stemming from the position of the baby during delivery occur in up to 30% of cases. Placental separation and bleeding due to placenta previa may cause anemia in the newborn
- 39. For the mother, bleeding and complications during cesarean delivery are the most common potential complications of placenta previa. Blood transfusions are necessary in one-third to one-half of the cases. In addition, 9 to 10% of placenta previa cases are associated with placenta accreta, an abnormally firm attachment of the placenta to the wall of the uterus. Placenta accreta prevents the placenta from separating from the uterine wall at the time of delivery. This can cause severe bleeding, often necessitating hysterectomy. Placenta accreta is particularly common in women who have placenta previa and a history of one or more previous cesarean sections. More than 50% of patients with placenta accreta require blood transfusions